Access to trauma centers.
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Health Services Accessibility↗
Biomedical subjects
John R Wish
Publications and source records attributed to John R Wish.
Better trauma care. How Maryland does it.
In March, 1970, the Maryland State Police, in cooperation with the University of Maryland, started the first statewide airborne transportation system. It was modeled after the army's success in Korea and Vietnam, where battlefield injuries were flown to front-line MASH units. The world's premier statewide medical aviation division was made possible through a cooperative effort between the Maryland State Police Aviation Division and Dr. R Adams Cowley at the University of Maryland Hospital as a public service to the citizens of the state. The Maryland Institute for Emergency Medical Services Systems (MIEMSS) has five components: (1) aircraft, (2) state troopers, (3) system communications (SYSCOM) center, (4) ambulance and fire emergency rescue, and (5) Level I adult and pediatric trauma centers and a regional burn center. The Maryland State Police Aviation Division now has 12 Aerospace Dauphin AS365N helicopters that operate out of eight fixed points throughout the state. Each helicopter has a two-person crew that consists of a pilot and a paramedic. Since 1993, the overall coordination of emergency medical services (EMS) has been under the purview of MIEMSS, an independent executive-level state agency that is governed by an appointed board and advisory council. To ensure stable funding for Maryland's world renowned emergency medical services (EMS) system, including med-evac helicopters, ambulances, fire equipment, rescue squads, and trauma units, a "surcharge" of $13.50 per year is collected with the automobile registration fee where applicable. The SYSCOM center in Baltimore coordinates the helicopter transport to the scene of the accident as well as referral to the specialty care facility: Adult Level I Trauma Center, Pediatric Level I Trauma Center, and Regional Burn Center. An on-the-scene evaluation of this exemplary emergency medical system in Maryland provides further convincing evidence of the performance of the Maryland State Police Aviation Division as they transported an injured child to the Johns Hopkins Pediatric Level I Trauma Center. It is our belief that the model emergency medical system in Maryland, if replicated throughout our nation, would save the lives of the critically injured.
Air Ambulances↗
An overview of revolutionary advances in emergency medical care in the United States.
One of the goals of this manuscript is to celebrate the influential and productive careers of three leaders in Emergency Medical Systems: Drs. James Mills, R Adams Cowley, and David Boyd. Through his courageous efforts, Dr. James Mills established the specialty of emergency medicine, with its own educational training programs, credentialing process, as well as a recognized society, the American College of Emergency Physicians. Dr. R Adams Cowley was the preeminent leader in developing an organized approach in trauma care in the State of Maryland, with the creation of the R Adams Cowley Shock Trauma Center. Many of the components of his comprehensive trauma program in the State of Maryland have been replicated in every state in our nation. Dr. David Boyd championed the development of emergency medical systems throughout our nation as he served as Director of the Office of Emergency Medical Service Systems in the Department of Health, Education, and Welfare. Under the guidance of Drs. Mills, Cowley, and Boyd, Dr. Edlich was a leader in developing emergency medical systems in the Commonwealth of Virginia. Unlike the comprehensive trauma system in the State of Maryland, the Commonwealth of Virginia, as well as other states in our nation, still lack statewide helicopter aviation services that bring critically ill patients throughout the state from the scene of injury to separate and distinct trauma facilities in which life saving trauma care can be initiated without admission to an emergency department.
Delivery of Health Care↗
Maryland State Police Aviation Division. A model emergency medical system for our nation.
This collective review has the following purposes. First we will describe each of the components of the Maryland State Police Aviation Division. We will then provide detailed information about the Atlas and Database of Air Medical Services (ADAMS) compiled by the center for transportation and injury research (Buffalo, New York) in alliance with the Association of Air Medical Services (Alexandria, Virginia) that provides a unique opportunity for each state to evaluate the comprehensive nature of their air medical services. The concept "the golden hour" has been molded into the world's premier public service aviation unit, which has proudly served the citizens of Maryland for over 24 years. This effort was initially made possible through a cooperative effort between the Maryland State Police Aviation Division and Dr. R Adams Cowley at the University of Maryland Hospital as a public service to the citizens of the state. This arrangement added a unique, economical, and life-saving component to the regionalized Emergency Medical Services and Critical Care system coordinated by the Maryland Institute for Emergency Medical Services Systems (MIESS). The Maryland State Police Aviation Division has four components: (1) aircraft, (2) state troopers, (3) system communications (SYSCOM) center, and (4) level I adult and pediatric trauma centers, as well as a regional burn center. ADAMS is a compilation of information of Air Medical Services in the United States to respond to traumas and other emergencies. Specifically, ADAMS provides descriptive and geographic information on Air Medical Service base locations, communication centers, rotor wing (RW) assets, and the major hospitals and transports that receive scene transports. The database includes all types of provider organizations including nonprofit, commercial, and public service (fire, police) air medical service providers, as well as several military units that routinely provide transport in remote areas. ADAMS provides national and statewide maps indicating air transport systems, trauma centers, and geographic population density. To provide a greater perspective on emergency medical care in individual states using the carefully tabulated ADAMS data, we compared the air emergency medical systems in Maryland to those of Oregon. Regardless of population density, Maryland provides air medical transport throughout the entire state, with the exception of only three small geographic areas. Maryland's 15 helicopter bases provide quick access for the seriously injured patient to either a Level I or pediatric trauma center within the "golden hour." In contrast, the air medical transportation system in Oregon is restricted to only three small geographic regions, making it an invitation to death for many seriously injured patients. It should be a federal mandate that the injured patient should gain access either by air transport or ambulance service to a Level I trauma center within that "golden hour." This federal legislation should include new criteria to initiate the dispatch of a helicopter to the scene of an accident or injury.
Air Ambulances↗
An organized approach to trauma care: legacy of R Adams Cowley.
The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. R Adams Cowley incorporated each of these 11 components for an organized trauma center into Maryland. In recognition of his landmark contributions to trauma, the eight-story Shock Trauma Center was named the R Adams Cowley Shock Trauma Center. There is growing evidence that this organized system in trauma care seen in Maryland must be replicated in every state in our nation. The results of the Health Resources and Services Administration Report in 2002 show serious limitations in our nation's organized approach to emergency and trauma care. This report indicates that many Americans do not have access to well-trained pre-hospital emergency personnel. Between 10 and 15% of the US population does not have access to basic emergency medical and communication services. Moreover, the presence of key trauma system components continues to vary throughout the country, most likely because of growing economic constraints. Emergency communication systems remain fragmented, and adequate training programs and protective equipment for health personnel remains notably absent. The threat of inadequate funding for the state manifests itself in the consistent uneasiness regarding the recruitment and continued retention of trauma care providers. Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans.
Disaster Planning↗
Auto launch/early activation: a survey of AAMS members and literature review.
BACKGROUND: Rapid access to definitive care is a fundamental tenet of trauma care and forms the basis for current emergency medical and trauma systems. Helicopters offer expedited transport to trauma centers and can deliver advanced practice personnel to the scene of injury, but many systems do not dispatch air medical crews until after assessment by ground providers. OBJECTIVES: Here we report data from the AAMS Auto Launch Survey and perform a literature review. METHODS: A 7-question survey was developed by the AAMS Research Committee and approved by the board. An invitation to participate in the survey was sent by electronic mail to all current members. A link to an online survey was included. Results were presented descriptively. Some respondents were willing to share auto launch protocols, which were categorized into patient-related factors, event-related factors, and geographic considerations. RESULTS: A total of 86 usable responses were recorded, which represented about a third of the 240 total AAMS members. Of these, 38 respondents (44.2%) routinely use auto launch. Just over half of those using early activation reported using a combination of event- and patient-related considerations; most also incorporating geographic criteria. About one-third of respondents auto launch only at the request of ground personnel, and about one-quarter use geographic criteria alone. Threshold distances ranged from 20 to 25 miles or 20 to 30 minutes by ground. CONCLUSIONS: About half of respondents routinely use auto launch, although protocols are not consistent. Auto launch appears to offer a mechanism for decreasing EMS response times, but additional research is needed to help define optimal dispatch criteria.
Air Ambulances↗
Hospital-division operations: Metro Life Flight.
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Accreditation↗